normal. He arrived at this conclusion from the fact that on examining the stomachs of such patients seven hours after a test-meal they were found empty.1 Ewald and Leyden hold that this is not sufficient evidence to prove that the digestion proceeds normally." Herzog, who has more recently studied the chemismus, found the conditions rather variable. In some cases there was hyperacidity, in others subacidity, and again in others. the acidity was normal. These varied conditions were associated with diverse conditions of the motility.3 In the cases reported by Boas in his recent book, there is a similar absence of anything like a positively abnormal condition of the chemismus. In my own experience I have found that these patients were always able to digest nitrogeneous food well, in fact that it agreed with them better than substances of the other alimentary groups. This clearly proves that a sufficient amount of HCl and of pepsin were present in the gastric secretion. In the last two cases that I had occasion to examine more fully, in accordance with modern methods, I found the total acidity rather high, though still within the normal limits as determined by Ewald and Boas. The same variability has been found in the motor power of the stomach. Leube holds it to be normal. Herzog? has found it both subnormal and normal. Bouveret maintains that there is atony of the whole gastro-intestinal tract. It must be borne in mind, however, that Herzog and Bouveret refer chiefly to cases of neurasthenia in which there is a general depression of muscular irritability. So far as my own experience goes I have never found any atony of the stomach, and I have most carefully examined for it. Judging, however, from what I have experienced in my own person, having suffered from the disease for quite a time, I should say that at the outset, immediately after the patient had finished eating, there seems to be an inhibition of all muscular action of the stomach, as if it were paralyzed. This inhibition lasts for a longer or shorter period-half an hour to an hour and a half-then ceases, and it has seemed to me that with the resumption of muscular activity the general phenomena begin to abate. In some of the cases coming under my observation, especially in those due to tobacco-smoking, I judged from the description given me that a like condition was produced in them. Upon this point there is no disagreement that in nervous dyspepsia there is nothing abnormal in the chemismus, and likewise the motor power cannot be said to be to any degree impaired. Wherein, then, lies the difficulty? All else being excluded, we naturally look to the nervous system. It can be assumed with a great deal of certainty that the sensory nerve of the stomach, the vagus, is in a state of hypersensitiveness, of exaggerated irritability, which manifests itself upon the ingestion of food by the pressure thus produced upon the ultimate nerve-filaments. The sense of weight, the feeling of pressure, the uneasy sensations in the stomach, the fact that food that taxes the stomach much causes greater distress than such as does not, all point plainly thereto. This irritation is transmitted to the nerve-centre, thence to other cerebral centres, and we have as a resulting manifestation the general irritability already described, and occasionally certain other phenomena which more properly pertain to neurasthenia or hysteria (hyperesthesias, feeling of heat and cold as in malaria, fibrillary tremor of tongue, feeling of palpitation, etc., globus, œsophagismus, hysterical ructus, paræsthesias, etc.). It can be very readily understood how, if the true character of the ailment remain unrecognized, or if it be not properly treated, the irritability may wax so great as to cause emesis, so that the greater part of the food is rejected almost as soon as taken or shortly thereafter. It also explains why these stomachs do not tolerate strong alcoholic liquors. 1 Deutsch. Archiv f. kl. Med., Bd. 23. * Zeitschr. f. kl. Med., Bd. 17. 2 Loc. cit. I have already stated that I believe, judging from my own personal sensations and confirmed by those of others, that an inhibition of all muscular activity of the stomach occurs at once upon the close of the meal. If such an arrest does take place it naturally involves a closure of the pyloric orifice. This would account for the feeling of distention of the stomach-the patients call it bloated-and for the relief afforded by belching; the gases produced in the process of digestion not being able to escape through the pyloric orifice distend the stomach and cause distress, and their discharge by eructation naturally brings relief. Upon the conditions already set forth, the occurrence of such a temporary arrest of muscular activity is very probable and not difficult of explanation. The irritation travelling through the vagi to the brain-centres, may have an effect upon the stomach similar to that which we see produced upon the heart when an interrupted current is sent through said nerve. This irritability is the sum and substance of the pathology of nervous dyspepsia. This view was, with some modifications, advanced by Leube in his first communication on this subject,2 though he seems to have receded therefrom in his subsequent address on this same topic before the Congress für innere Medizin, 1883. As to the causes of this hyperirritability, they are, of course, the etiological factors already named. As to mental shock, although we do not know by what manner of process it acts upon the human system, we do know that it does so act, and that it is through the nervous system that its influence is made manifest. The effect appears to be rather varied in its nature. It may show itself in disturbed function of one or the other or gan. 3 The sudden disappearance of all hunger, of all appetite, upon the receipt of evil tidings, and the marvellous rapidity with which good news will change a person who has been depressed for months, is a matter of general knowledge. Numerous observations are extant of its influence upon the liver, as to disturbance of the biliary and of the glycogenic functions. It may show itself by abnormal states of the nervous system, hysteria, neurasthenia, melancholia, etc. It is, therefore, not at all far-fetched to assume that a state of hyperirritability of the gastric nerves should have been produced thereby, more especially as the stomach seems to be the organ upon which the effect of the shock was chiefly expended. That tobacco-smoking may affect the stomach has long been known. Without laying any especial stress upon the experimental results obtained in animals, the experiments partaking more of the nature of acute poisonings, I would say this much from careful clinical observation : In some cases in which the digestion was of normal character, smoking a cigar shortly after a full meal gave rise to the sense of weight, of fulness, of oppression; it seemed (and this I have myself experienced) as if the digestive process had been at once arrested; there is the same feeling as if the muscular activity of the organ had been inhibited, and as a result thereof the fulness, the distention. Smoking several hours after full meals can produce a like effect, plus, in some individuals, a pyrosis. There is secreted, under its influence, an acid fluid which causes a burning sensation in the pit of the stomach, and if regurgitated will set the teeth on edge. Smoking upon very light meals, after coffee, will with some persons cause pyrosis.* Smoking immediately before meals may destroy the hunger, banish all appetite; if the person eats nevertheless, he will most likely have a whole train of unpleasant sensations. I have known smoking to produce cardialgia. As to its action upon the nervous system, I 1 M. Foster: Human Physiology, 1880. Deutsch. Arch. f. kl. Med. und Verh. d. Congr. f. in. Med, loc. cit. 3 Tuke: The Influence of the Mind upon the Body. That smoking may excite pyrosis is mentioned in Der Tabak u. seine Einwirkung, Ludwig Jankau, München, 1849. Richardson: Diseases of Modern Life. 1 3 have observed, in connection with the dyspeptic phenomena the general irritability already described. I have noted dizziness, vertiginous sensations, and general tremor. Schotten 1 reports that he has observed hyperesthesia of various nerve-tracts produced by smoking; he has also noted the vertiginous feeling and a hyperesthesia psychica; disturbances of motility, muscular spasm, tremor, etc. Gilbert reports a case of what he calls "hystérie tabagique."2 Strümpell cites tobacco-smoking as one of the etiological factors of various maladies of the nervous system. That tobaccosmoking has a special predilection for the vagus nerve, is shown by the many cases of dyspepsia and the striking cases of tachycardia, reported by numerous authors, and a number of which I have myself seen. It can therefore, in view of all this, be assumed, and the assumption is fully justified, that a state of hyperirritability of the sensory nerve of the stomach has been developed, and that the pathological process is the same here as already described. The assumption is fully borne out by the symptomatology, and furthermore all the manifestations described are understood and accounted for. Diagnosis. Although, as already stated, both Leube and Leyden held that it was impossible to make a diagnosis of nervous dyspepsia, I firmly believe that, within the limits set down, and bearing in mind the nature of the ailment and its symptomatology as already described, there can be no difficulty in making an exact diagnosis, and from the outset. With the pres ent methods of examination and our advanced knowledge of gastric pathology, it is almost impossible, I hold, to mistake nervous dyspepsia for ulcer of the stomach or gastric catarrh, and vice versa. One, two, at most three, careful examinations with acquisition of the previous history will soon set us right. There is therefore no necessity for going into detail as to the differential diagnosis between them. The only form of gastric disturbance with which it can be confounded is what, with Burkart and Ewald, I would call neurasthenia gastrica, and from this it can be differentiated by the following and divergent characteristics: In a word, in neurasthenia gastrica more or less of the characteristic features of neurasthenia are always present. Prognosis and Duration.-The prognosis is set down by eminent writers as very unfavorable; taking my own experience into consideration, and it has been sufficiently large to justify my expressing an opinion, I must say that the prognosis of nervous dyspepsia, as described here, is decidedly a favorable one; even in cases of long standing, if the proper methods be employed recovery will ensue, and in comparatively short time, as can be seen from Case I. In all my experience I have had but one case of nervous dyspepsia that I failed to relieve, and this was a person of gluttonous habits who informed me that she would never submit to any dietary regulations and deprivations. As to duration, that varies. The trouble cannot be said to have a fixed limit of time, in the sense that it runs its course and then abates, as for instance typhoid fever; the duration of nervous dyspepsia is dependent upon the following circumstances: whether the true nature thereof is promptly recognized by the physician ; whether it is properly treated; whether the patient has sufficient self-control to observe the strict dietary regulations necessary to his recovery. Thus it will be seen that in Cases I. and VI. the disease lasted a long time, though the duration was short after the proper treatment was instituted; Cases III. and V., which came very soon under observation and were at once appropriately treated, were of rather short duration. Complications. I have never observed any, except a slight eczema on the chin, which requires no especial attention and which disappears as soon as the stomach is better. Sequelæ. It has been said by good authority that nervous dyspepsia may result in severe and even dangerous forms of gastric disease. So far as my own experience goes, I have never observed any of these dangerous sequelæ; even cases of very long standing have made a comparatively quick and good recovery. I believe, however, that, given a predisposition thereto, insanity of the melancholy type may result. This belief is not based upon any personal knowledge, but solely upon the observation, rather frequently made, that these patients incline to melancholia, and from reports of insane asylums. CASE I.-Mrs. K- , aged thirty, consulted me in Cincinnati, October 25, 1885. She walked very feebly. into my office, dropped into a chair, and closed her eyes as if she were about to faint. I ran quickly for some Hoffman's anodyne, ordered some cold water to be brought, etc. The lady, however, soon opened her eyes and said I need not feel alarmed, that she was not going to faint; continuing, in a very low tone of voice, 1 See Lowenfeld, Pathologie u. Therapie der Neurasthenie u. Hysterie. 2 I mean by this that though he be ever so sleepy while sitting up, sleep flies from him as soon as he lies down in his bed. so low that I had to lean forward in my chair to catch She History Mrs. K― is from New York City, having lived there for over seven years, from the time of her marriage up to within two weeks of the date given, when she joined her husband in Cincinnati, where he had established himself in business. She has been married seven and a half years, but is as yet childless. Already in her maidenhood she was occasionally troubled by her stomach; occasional attacks that would last but a short time and disappear. As to the nature of these early attacks I could learn nothing definite. She seemed to have no distinct ideas either as to the symptoms that were produced, as to the length of time they lasted, or as to the length of interval at which they appeared. After marriage the attacks came on more frequently and grew more severe. During this illness, During this illness, which has lasted the whole period of her married life, she consulted some of the most reputable physicians in this city. She consulted first the well-known general practitioners, who all advised the free use of alcoholic stimulants, brandies, wines, etc., good nutritious diet, and plenty of it. The opinion was expressed that she was either on the verge or already affected with phthisis pulmonalis. She was advised not to sleep on feather-beds, to avoid dust, etc. Later on, upon the advice of relatives, she consulted several eminent gynecologists, the female relatives having been of the opinion that her stomach trouble was due to some uterine complaint or to her sterility. She saw some quite eminent men, whom she named to me, and heard various opinions as to the nature of her trouble and as to what she might expect. Upon this, however, they were agreed, that she would have to undergo a serious operation, as all her ailments were due, according to one to the uterus, according to another to the ovaries Some thought that she might become fecund after prolonged treatment, others declared that she was permanently sterile. She wandered about thus from one physician to another without being benefited. She consumed, and still consumes, large quantities of alcoholic liquors, two to three bottles of brandy per week, and four to five bottles of good Rhine wine. liquor bills are so large that Mr. K says they keep him poor. She takes milk freely in the shape of milkpunch and otherwise. At the outset of her sickness she vomited very rarely, but since several years she vomits almost every time that she takes food; liquors especially are quickly rejected, almost as soon as swallowed. The Status Præsens.-Mrs. K- is a tall woman, five feet seven inches in height; large-boned; she is extremely emaciated, does not weigh more than 85 to 90 pounds; her face is thin and peaky; the skin is dry and has a dark-yellow teint; her cheek-bones stand out prominently; her eyes are unnaturally large and have large rings around them; her lips are thin and pale; when she speaks her gums are entirely visible, they are very red in color and soggy in appearance, very much like what is seen in scurvy; her teeth are bad. She is so weak that she can hardly drag herself along. Examination.-Lungs perfectly sound, although the respiratory murmurs are feeble. Heart normal, heart's action very weak, as in greatly enfeebled persons. Pulse 65, weak and easily compressible. Abdomen: As she expressed herself, she has no belly at all; the abdomen presents a scaphoid appearance, the walls having fallen in so as almost to lie upon the vertebral column. A careful examination revealed nothing abnormal. The epigastric region was carefully palpated throughout its whole extent; nothing was discovered; no pain was elicited on pressure. As she had already seen so many gynecologists and they had differed in opinion, I concluded to dispense with an examination of the genital tract, as evidently not much would be learned therefrom. The tongue presented a very thin white coat, and upon the tip a few elongated papillæ were noted. Bad taste in the mouth. While she eats the food tastes good to her, and she can eat as much as anybody; but when she ceases eating then comes that miserable feeling of weight, a feeling of oppression which is momentarily relieved by an eructation; then comes an uneasiness, a restlessness over the whole body; this all continues until the greater portion of the food is vomited. The emesis is hastened by the brandy or whiskey which she generally takes with the view of relief from the distressful symptoms recounted. There is no globus, no headache. The depression that exists is due to the belief impressed upon her by physicians that she is afflicted with an incurable disease. There is some tenderness of the shin-bones, there is some rachialgia; this is, however, undoubtedly due to the fact that the muscles of the back are greatly wasted, and that it requires great efforts on the part of the patient to hold herself erect. Her feet are nothing more than skin and bone, and consequently walking in the thin-soled shoes worn by ladies is exceedingly painful to her. An examination of the stomach contents was left in abeyance, as the general condition of the patient would not warrant it. The question of the presence or absence of HCl in the gastric juice I would determine by dietary methods. She sleeps badly, that is, she sleeps only in short snatches; she cannot sleep two hours at a stretch. Despite her marked emaciation and the greatly debilitated condition of the patient, I put her upon a rigorously restricted diet in accordance with the rules I had formulated for myself in the treatment of such cases. Medication was but trivial. The whole treatment was a local one and directed solely to the stomach. December 2, 1885.-The treatment has been perseveringly followed; the patient feels much better. She has improved greatly in her general appearance, and her face and figure both show that she is gaining in flesh. She is much easier after meals-in fact, the previous unpleasant sensations after eating are now almost altogether wanting. She sleeps well, stools (which I always direct to be carefully inspected) are normal. About this time she requested that I make some change in her diet, and I permitted the use of chopped raw beef in place of the meat that she had been taking till now. Some additional change was also made in her drink. December 20th.-Patient informs me that she has seen some white bands in her stool. She was directed to bring some for examination. They were the proglottide of the tænia medio-canellata. The raw beef was immediately discontinued, but owing to her still weak condition I did nothing toward expelling the worm. About the first of February, the patient having gained greatly in strength, I prescribed an emulsion of pumpkin seed, followed this up with some kousso, and she expelled one piece about twenty inches long, and the following day a second piece ten inches long. The proglottidæ showed that the worm was still young. No more was seen after this. March 15, 1886.-The patient is doing very well; she is much fuller in the face, rounding out in the abdomen, and altogether has gained considerably in flesh. At the end of April, 1886, Mrs. K― informed me that she was pregnant, and in the beginning of February, 1887, she was delivered of a fine, healthy boy. Mrs. Khas since continued to do her duty as a good wife, and has presented her husband with four healthy children. She is now living in a large city of the State of Pennsylvania, and is in good health and con-` dition. CASE II.-Mrs. R—, aged fifty; woman of five feet five inches in height; well built; of good muscular development. Mother of four children-two boys and two girls, all grown. She has a prolapsed uterus, for which she wears a ring pessary which is removed once a year, and not returned for eight to ten days, in which time she keeps her bed. She has a very mobile, nervous temperament. She has had many struggles in this life on account of a husband who was given to spendthriftness; and a son, who was a good-for-nothing and, still worse, caused her great grief. She is generally a lively She is generally a lively woman, loves to go out and visit, and to enjoy some of the good things of the world. She is a very active woman, attends to her whole household, doing her own work, cooking, cleaning, etc. In January, 1889, I was called to attend Mrs. Rfor an acute laryngitis. At this time she was also under treatment with a gynecologist for the prolapsed uterus. I treated her for about a week, and the case not progressing satisfactorily I advised her that it would be best for her to place herself in the care of a throat specialist and left the case. My advice was not followed; the gynecologist treated her laryngitis; she used liniments that blistered her neck and kept it raw for nearly six weeks. She was confined absolutely to her room for four full weeks. About March 1st I was called again. I found her very much depressed, melancholy, given to tears, to dark broodings, etc. Not being able to elicit much, I took it for granted without further examination that she was hysterical and told her so, and prescribed some tincture of valerian. Her confidence in my medical skill was now greatly weakened, and upon the advice of friends she placed herself in the care of a quite eminent neurologist. She was medicated, treated with galvanism, with static electricity, shock to the spine, etc. She was ordered to eat plenty of good nutritious food. I About the early part of June I was called again—at this time I did not know that she had been in the hands of a nerve specialist; I did not learn this until some time after the patient had fully recovered. found her as I had seen her before, melancholy, despondent; her face expressive of gloomy thoughts and dark forebodings; she cried much and readily. She spent most of her time on a chair or on the lounge, and appeared to have lost all energy for work and all desire for dress. Her pulse was slow and weak. She slept badly, she could not go to sleep on account of the gloomy thoughts that troubled her. She was losing flesh rapidly, and was very much thinner than when I had seen her in March. She ate fairly well-she had always been a hearty eater. Bowels sluggish. Questioned more closely, she informed me that at the time when she was confined to her room something had occurred that had troubled her greatly in her mind, had called back the business reverses of her husband-she was the financial manager of the family-and that her appetite, which had already become poor from the confinement, was then altogether lost. She ate, however, as usual, perhaps even more frequently, as she felt weak and wanted to gain strength. After eating she felt badly; she had a sense of oppression and weight in the pit of her stomach; she wanted to belch, and belching always gave her a little relief. She always felt more despondent after eating; she was very irritable then and could not bear to have anybody talk to her. This fact that she was always at her worst after meals was also observed by the daughter, a very intelligent and cultivated young lady. A physical examination revealed nothing; the chemismus was not investigated, as the patient would not allow it. I did not insist, for to me the diagnosis was clear. That the chemismus' must be of normal character I judged by the fact that, though the patient took large quantities of food, there was no dilatation and no diarrhoea. The tongue was coated with a white coat, looking like a layer of saliva. The plan of treatment that had given such an ex cellent result in Case I. was prescribed for Mrs. R—. In addition to this I directed that she resume her previous habits of exercise, working about the house, going out shopping, or promenading. To allay the gnawing sensation, which she felt some hours after meals, she must take nothing but two table-spoonfuls of milk, or the same quantity of ice-water. She observed the rules and regulations carefully for two weeks and was doing very nicely, being greatly improved physically and psychically, when she concluded that she might allow herself greater liberties in her diet. This over-indulgence brought its own punishment with it. There was an immediate return of the previous distressing sensations; she became despondent again; in short, she relapsed into her former state. I was called to see her. Surmising the cause of her relapse, I questioned her whether she had not disregarded her dietary regulations; she denied absolutely that she had done so, but her daughter happened to come into the room just then, and to my question replied that her mother had been grossly disobedient; that a constant watch had to be kept upon her to make her observe the rules of treatment; that on that day, the daughter being compelled to go out, the mother took advantage of her absence and ate what she called a square meal. I gave the daughter the necessary directions; the mother I lectured upon the folly of her conduct, painted in dark colors what would be the result of following her own bent, and in bright tints the reward of obedience. In two days she was better. July 5, 1889.-She continues to improve rapidly. The unpleasant sensations consequent upon eating have almost entirely disappeared; she is in good spirits and attends to her duties as before; she sleeps well. Her face shows a gain in flesh. Treatment, with some slight modifications, to be continued. August 1st.-Patient is doing excellently; she is regaining flesh and strength rapidly. The nervous phenomena have disappeared entirely. With some advice as to her diet and some other things pertaining to the modus vivendi for the next few months, I discharged her cured. She has continued in good health, and has had no further trouble with her stomach. CASE III.-Miss M- aged thirty; of ordinary stature, about five feet in height, and rather poor in flesh now. She has always been hale and hearty and of a merry disposition; never knew what it was to have nerves. She is a teacher, and taught school up to within a short time. October 14, 1882.-Some months ago she had some great trouble, the exact nature of which I could not learn, and since then she has been greatly depressed, melancholy, in fact. She will not go out, and avoids all society. At one time she had pains between the shoulder-blades, but that is gone now. She sleeps well, but only for a few hours. She has no hunger, and therefore does not want to eat; her family, however, insists upon her eating, and when she has once begun to eat she can keep right on, as the food tastes good to her; but when she is through, then she wishes she had not eaten at all. She has then a sense of fulness as if her stomach were distended, a sense of weight in the epigastrium, which is relieved for the moment by an eructation. There is a general uneasiness of the whole body that will not allow her to sit down, but keeps her moving up and down the length of the room. After an hour or two, according to the character of the meal she has taken, she feels somewhat easier, and then she sits down in a corner and mopes and broods and cries. Tongue coated with thin, white, transparent coat; the papillæ about the tip are somewhat elongated. Bowels constipated. Physical examination reveals nothing abnormal. The patient was put upon the treatment usually pursued by me in these cases. In two weeks she was already much better, and in five weeks from the time treatment was instituted, the patient was discharged cured. CASE IV.-E. R, aged fifty; man, five feet ten inches in height, broad-shouldered, of excellent physical development generally. A university man of superior attainments. He has led a very active life as a business man, lawyer, justice, and politician in the great Northwest. He is a good liver, drinks moderately, and smokes considerably. In 1870 he became the editor of a large daily paper; he continued in this position till the end of 1874, when he was forced out. He resumed the practice of the law. In 1876, having lost what little he had had, the law practice not remunerative, and the times very stringent, he had a hard struggle and a great deal of mental worry. About the middle of the year he began, for economical reasons, to make his own cigars, and these were very strong. In January, 1877, he sent for me. He complained of unpleasant sensations in his head-an inability to study. No especial desire for food, though he can eat when it is placed before him. After eating he feels very much distressed; he has a sense of weight in his epigastrium; his stomach feels as if it were distended; an eructation gives relief for the moment. Stools regular. Sleeps well. He has lost flesh. Physical examination reveals nothing abnormal. Tongue coated with a thin, white, transparent coat; some elongated papillæ about the tip and edges. As in this case both etiological factors were present, and it was a question in my mind whether one or both had produced the morbid state of the patient, I ordered, besides the usual treatment, absolute rest from mental work; no reading or studying at all; sufficient physical exercise by walking or working in the garden. At the end of four weeks the patient was very much better; at the end of three months he was entirely well and discharged from treatment. CASE V.-C. H-, aged thirty; man, of ordinary stature, about five feet six inches in height; of ordinary muscular development; light complexion. Drinks moderately, but smokes much. Usually enjoys good health, and is capable of great exertion. He went through a rather protracted siege of typhoid fever. lately, but has fully recovered therefrom. He called to consult me in January, 1890. He complained that after eating he had a fulness in the stomach, a sense of weight, a feeling of distention; a voluminous eructation would afford momentary relief. He has a feeling of giddiness in the head; a general irritability comes over him, so that it is almost impossible for him to attend to business. After the disagreeable sensations described have passed, he has a gnawing in the pit of his stomach, for which he takes a little whiskey and soda. The bowels are normal. Sleep is good. He has suffered from these dyspeptic attacks for quite a number of years. I also learned that he was a good liver, liked rich food, and always smoked strong cigars after meals. He feels weak and keeps thin. A physical examination revealed nothing abnormal. I directed him to take a test-breakfast the next morning, and to be at my office an hour thereafter for examination. One hour and twenty minutes after taking the breakfast I removed from his stomach about twenty cubic centimetres of nearly semifluid material. Nothing abnormal in its appearance. The bread was well worked up with the water. Reaction with blue litmus markedly acid. Strong reaction with phoro-glucinvanilline. I gave him the usual directions for treatment. A week later I saw him again; he was feeling splendidly, never better in his life. Three months later he called again, complaining of the same distressing feelings that had annoyed him before. I taxed him with having violated the rules of living laid down for him, and he acknowledged that he had done so ; he had forgotten himself at a supper, and eaten and smoked contrary to his rules. He recovered quickly. He is splendid condition; has grown strong and stout. is not been troubled either in his head or in his h for more than a year. VI.-J. W, aged twenty-two; five feet five inches and a half in height; weight, one hundred and He About five years ago, one Sunday, in the midst of his dinner he suddenly had a feeling of weight in his stomach, as if lead were lying there. He had to stop eating then and there; shortly thereafter he was seized with cramps in his bowels. This became a sort of habit with him, and he had cramps after every meal; he had to go to stool and then the pain ceased. Sometimes, however, a queer sensation remained for a time. treated himself with home remedies; he had considerable intervals of freedom from suffering. At the end of a year and a half he was altogether much worse, and concluded to consult a physician. He did so, but was not relieved; he consulted another physician, who ordered him to drink a cup of hot water every morning, and gave him some powders to aid digestion. He drinks beer, but very moderately. He smokes seven cigarettes and one cigar a day. He smokes since his twelfth year. He eats two meals a day. According to what he has been told, he has had catarrh of the stomach for the last ten years. Present condition: Careful physical examination reveals nothing abnormal. Reflexes normal. Teeth good. Tongue coated with white fur and rather broad; some elongated papillæ at the tip. He has a bitter taste in his mouth. He has no hunger. He has a sense of weight, of oppression in his stomach immediately after eating. He wants to belch; after belching he feels easier for a few minutes. Bowels usually regular. He is down-hearted; out of humor; after eating a feeling of irritability comes over him, so that he would like to pick a fight with any and everybody. This wears off gradually. When his attention is attracted by other matters in which he is greatly interested his dyspeptic phenomena soon disappear. When he wakes up in the morning he feels badly; sometimes it is sharp pain. Stomach shows nothing abnormal; no atony. August 27, 1894.-Withdrew from patient's stomach about 50 c.c. of residue an hour and fifteen minutes after a Boas test-breakfast. Examination: No odor. Appearance as it should be; the bread very well worked up. (Patient is not accustomed to drinking water, not even in summer.) |